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0byt3m1n1
0byt3m1n1
Path:
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hermes
/
bosweb
/
b744
/
chastityconn.com
/
public_html
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webservice3
/
[
Home
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File: preliminaryinformation.php
<?php ob_start(); session_save_path("/home/users/web/b320/dom.fayettebiz/cgi-bin/tmp"); session_start(); //exit(); include('include_preliminaryinformation.php'); ?> <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <title>PRELIMINARY INFORMATION Page 1 of 7</title> <style> .content{ font-family:Calibri 11, Calibri, sans-serif ; background-color:#FFFFFF; border:1px solid; top:20px; position:absolute;} .selectInput{ width:150px; padding:2px; text-align:center; border:1px solid #000000;} .selectInput2{ padding:1px; text-align:center; border:1px solid #000000;} .selectInput3{ padding:1px; border:1px solid #000000;} .tetboxfield{ border:1px solid #000000;} .style1 {margin-bottom: 10px; font-weight: bold; } .error{ color:#FF0000; margin:4px;} .links{ color:#000000; text-decoration:underline; font-weight:bold;} .links:hover{ color:#feac00; text-decoration:underline; font-weight:bold;} .red { font-family: Arial; font-size: 13px; color: #F00; } </style> </head> <script src="js/common.js" type="text/javascript"></script> <script src="js/ajax.js" type="text/javascript"></script> <script> function showPopup(url) { newwindow=window.open(url,'name','height=360,width=440'); if (window.focus) {newwindow.focus()} return false; } function showPopup1(url) { newwindow1=window.open(url,'name','height=360,width=440'); if (window.focus) {newwindow1.focus()} return false; } function validateEmail(emailId) { alert('inside function'); if(trim(emailId) != '') { var ajax = new Ajax(); ajax.doGet('getDataCheck.php?act=emailCheck&email='+emailId,data,'text'); } } var data = function(str){ if(str == 'taken') { var msg = 'You have already registered for TeenWork and will be contacted with a response in 30 days of your first application submission.'; document.getElementById('emailCheck').value= 'taken'; document.getElementById('showErrorMsg').style.display = ''; document.getElementById('showErrorMsg').innerHTML=msg; setFocus('busername'); } } function birthrange_old(month, date, year) { month= month-1; var minYear = '1991'; var minmonth = '6'; var mindate = '1'; var maxYear = '1996'; var maxmonth = '6'; var maxdate = '1'; userdate = new Date(year, month,date); mindate = new Date(minYear, minmonth, mindate); maxdate = new Date(maxYear, maxmonth, maxdate); if(userdate > mindate) { var msg = 'less'; } else if(userdate < maxdate) { var msg = 'greater'; }else { var msg = 'correct'; } return msg; } function birthrange(month, date, year) { if(year == '1991') { if(month >6) { var msg ='invalid'; }else if(month == 6) { if(date >=2) { var msg ='invalid'; } } } if(year == '1996') { if(month <5) { var msg ='invalid'; }else if(month == 5) { if(date <=31) { var msg ='invalid'; } } } return msg; } function validateEmailagain(emailId) { if(trim(emailId) != '') { var ajax = new Ajax(); ajax.doGet('getDataCheck.php?act=emailCheck&email='+emailId,output,'text'); } } function output(str) { if(str == 'taken') { var msg = 'You have already registered for TeenWork and will be contacted with a response in 30 days of your first application submission.'; document.getElementById('emailCheck').value= 'taken'; document.getElementById('showErrorMsg').style.display = ''; document.getElementById('showErrorMsg').innerHTML=msg; setFocus('busername'); } } function age123(){ year1 = document.getElementById('year').value; day1 = document.getElementById('date').value; mnth1 = document.getElementById('month').value; if(year1 != "" && day1 !="" && mnth1 !=""){ var age = parseInt((parseInt(year1)) - (2010)); //document.getElementById('age').value = -(age); }else{ //document.getElementById('age').value = ""; } } function validatepage1() { var fosterYouth = document.getElementById('fosterYouth').value; var foodstamps = document.getElementById('foodstamps').value; var tanf = document.getElementById('tanf').value; var iep = document.getElementById('iep').value; var dependent = document.getElementById('dependent').value; var ques6 = document.getElementById('income_eligible').value; if(fosterYouth == 'n' && foodstamps=='n' && tanf=='n' && iep=='n' && dependent=='n' && ques6 == 'n'){ var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please dont be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search</a> section of our website that may aid in helping you get ready for your search.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; return false; } if(isEmpty(trim(getObject('fosterYouth').value))) { var errMsg="<p align='center'>Are you are currently a foster youth in the state of Georgia?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('fosterYouth'); return false; } else if(isEmpty(trim(getObject('foodstamps').value))) { var errMsg="<p align='center'>Does anyone in your household receive food stamps?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('foodstamps'); return false; } else if(isEmpty(trim(getObject('tanf').value))) { var errMsg="<p align='center'>Do you or anyone in your household receive TANF?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('tanf'); return false; } else if(isEmpty(trim(getObject('iep').value))) { var errMsg="<p align='center'>Do you have a current IEP?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('iep'); return false; } else if(isEmpty(trim(getObject('dependent').value))) { var errMsg="<p align='center'>Do you have a dependent?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('dependent'); return false; } // else if(trim(getObject('fosterYouth').value) != 'y' && trim(getObject('foodstamps').value) !='y' && trim(getObject('tanf').value)!= 'y' && trim(getObject('iep').value) != 'y' && trim(getObject('dependent').value) != 'y' && trim(getObject('custodial').value) != 'y') // { // var errMsg="Please answer 'Yes' to at least one of these 6 questions"; // var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search</a> section of our website that may aid in helping you prepare for your job search.<br /><br /></p>"; // getObject('showErrorMsg').style.display = ""; // getObject('showErrorMsg').innerHTML = errMsg; // setFocus('fosterYouth'); // return false; // } if(isEmpty(trim(getObject('month').value)) || isEmpty(trim(getObject('date').value)) || isEmpty(trim(getObject('year').value))) { var errMsg="<p align='center'>Please enter your birth date. It cannot be empty.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; if(isEmpty(trim(getObject('month').value))) { setFocus('month'); } else if(isEmpty(trim(getObject('date').value))) { setFocus('date'); } else if(isEmpty(trim(getObject('year').value))) { setFocus('year'); } return false; } else { //June 15th 1989 to June 15th 1996 var month = document.getElementById('month').value; var date1 = document.getElementById('date').value; var year = document.getElementById('year').value; if(year == 1991){ if(month < 6){ var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search </a>section of our website that may aid in helping you get ready for your search. <br <br /></p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; return false; } } if(year == 1996){ if(month == 6 && date1 > 1){ var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search </a>section of our website that may aid in helping you get ready for your search. <br <br /></p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; return false; } if(month > 6){ var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search </a>section of our website that may aid in helping you get ready for your search. <br <br /></p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; return false; } } //end date // var birthMsg = birthrange(trim(getObject('month').value), trim(getObject('date').value), trim(getObject('year').value)); // if(birthMsg == 'invalid') // { //var errMsg="Sorry, but only those can register who are born in between June 1, 1989 AND January 1, 1996."; // var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search. </a/>section of our website that may aid in helping you. get ready for your search <br <br /></p>"; // getObject('showErrorMsg').style.display = ""; // getObject('showErrorMsg').innerHTML = errMsg; // return false; // } } if(isEmpty(trim(getObject('income_eligible').value))) { var errMsg="<p align='center'>Are you or anyone in your household income eligible?</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('income_eligible'); return false; } if(isEmpty(trim(getObject('city').value))) { var errMsg="<p align='center'>Please enter your City . It cannot be empty.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('city'); return false; } else if(!isChar(trim(getObject('city').value))) { var errMsg="<p align='center'>City can contain only alphabet characters.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('city'); return false; } if(isEmpty(trim(getObject('state').value))) { var errMsg="<p align='center'>Please select your State. It cannot be empty.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('state'); return false; }else if(trim(getObject('state').value) == 'Oth') { var errMsg="<p align='left'>You do not qualify for the Georgia TeenWork summer program. However, please don’t be discouraged in looking for summer employment. There are many benefits to youth working and you are on the right track. There is a <a href='http://www.georgiateenwork.org/preparing_for_job_search_resources.html' class='links' target='_blank'>Preparing for Your Job Search </a>section of our website that may aid in helping you get ready for your search. <br /><br /></p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('state'); return false; } if(isEmpty(trim(getObject('email').value))) { var errMsg="<p align='center'>Please enter your email address. It cannot be empty.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('email'); return false; } else if(!isEmail(trim(getObject('email').value))) { var errMsg="<p align='center'>Email format should be youremailaddress@example.com.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('email'); return false; }else { validateEmailagain(trim(getObject('email').value)); var avail = trim(getObject('emailCheck').value); if(avail == 'taken') { var errMsg="<p align='center'>You have already registered for TeenWork and will be contacted with a response in 30 days from your original application submission.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('email'); return false; } } if(isEmpty(trim(getObject('age').value))) { var errMsg="<p align='center'>Please enter your age.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('age'); return false; }else if(!isNaN(getObject('age').value)) { if(parseInt (getObject('age').value) < 100) return true; else { var errMsg="<p align='center'>Must be 2 digit</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('age'); return false; } } else { var errMsg="<p align='center'>Please enter your age.</p>"; getObject('showErrorMsg').style.display = ""; getObject('showErrorMsg').innerHTML = errMsg; setFocus('age'); return false; } return true; } </script> <body bgcolor="#888888"> <form name="frm_page1" action="" method="post" onsubmit="return validatepage1();"> <table width="98%" border="0" cellpadding="0" cellspacing="0" class="content"> <tr> <td colspan="3" height="10"></td> </tr> <tr> <td colspan="3"><span style="margin-left:30px;"><strong>PRELIMINARY INFORMATION Page 1 of 7</strong></span></td> </tr> <tr> <td colspan="3" height="30"><div id="showErrorMsg" class="error"></div><div class="error" align="center"><?php if(isset($_REQUEST['msg'])){echo $_REQUEST['msg'];}?></div></td> </tr> <tr> <td width="5%" align="center" class="style1">1.</td> <td width="63%">Are you a current or former foster youth in the state of Georgia?</td> <td width="32%"><select name="fosterYouth" id="fosterYouth" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['fosterYouth']) && $_SESSION['fosterYouth'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n"<?php if(isset($_SESSION['fosterYouth']) && $_SESSION['fosterYouth'] == 'n'){ echo "selected";}?>>No</option> </select></td> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center" class="style1">2.</td> <td>Does anyone in your household receive food stamps?</td> <td> <select name="foodstamps" id="foodstamps" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['foodstamps']) && $_SESSION['foodstamps'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n" <?php if(isset($_SESSION['foodstamps']) && $_SESSION['foodstamps'] == 'n'){ echo "selected";}?>>No</option> </select></td> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center" class="style1" valign="top">3.</td> <td>Do you or anyone in your household receive TANF <br /> (Temporary Assistance for Needy Family)?</td> <td><select name="tanf" id="tanf" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['tanf']) && $_SESSION['tanf'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n" <?php if(isset($_SESSION['tanf']) && $_SESSION['tanf'] == 'n'){ echo "selected";}?>>No</option> </select></td> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center" valign="top"><strong>4.</strong></td> <td>Do you have a current <a class="popup" onclick="showPopup1('http://www.georgiateenwork.org/IEP.html')" style="text-decoration: none;" href="#">IEP</a> (Individualized Education Plan)? <br /> </td> <td><select name="iep" id="iep" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['iep']) && $_SESSION['iep'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n" <?php if(isset($_SESSION['iep']) && $_SESSION['iep'] == 'n'){ echo "selected";}?>>No</option> <option value="I Dont Know" <?php if(isset($_SESSION['iep']) && $_SESSION['iep'] == "I Don't Know"){ echo "selected";}?>>I Don't Know</option> </select> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center"><strong>5.</strong></td> <td>Do you have a child?</td> <td><select name="dependent" id="dependent" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['dependent']) && $_SESSION['dependent'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n" <?php if(isset($_SESSION['dependent']) && $_SESSION['dependent'] == 'n'){ echo "selected";}?>>No</option> </select> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center" class="style1" valign="top">6.</td> <td>Is your household income-eligible based on the Georgia TeenWork program eligibility requirements? <a class="popup" onclick="showPopup('http://www.georgiateenwork.org/poverty.html')" style="text-decoration: none;" href="#">Click Here </a>for household income requirements. <br /> </td> <td><select name="income_eligible" id="income_eligible" class="selectInput"> <option value="">--Select here--</option> <option value="y" <?php if(isset($_SESSION['income_eligible']) && $_SESSION['income_eligible'] == 'y'){ echo "selected";}?>>Yes</option> <option value="n" <?php if(isset($_SESSION['income_eligible']) && $_SESSION['income_eligible'] == 'n'){ echo "selected";}?>>No</option> </select></td> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center"><strong>7.</strong></td> <td>Birth Date</td> <td><select name="month" id="month" class="selectInput2" > <?php $currentDay = date('d'); $currentMonth = date('m'); $currentYear = date('y'); ?> <option value="" >Month</option> <?php for($i=1;$i<=12;$i++) {?> <option value="<?php echo $i;?>" <?php if($_SESSION['month'] == $i){ ?> selected <?}?>><?php echo $i;?></option> <?php }?> </select> <select name="date" id="date" class="selectInput2" > <option value="">Date</option> <?php for($j=1;$j<=31;$j++) {?> <option value="<?php echo $j;?>" <?php if($_SESSION['date'] == $j){?> selected <?}?>><?php echo $j;?></option> <?php }?> </select> <select name="year" id="year" class="selectInput2" > <?php for($y=1991;$y<=1996;$y++) //onChange="age123();" {?> <option value="<?php echo $y;?>" <?php if($_SESSION['year'] == $y){?> selected <?}?>><?php echo $y;?></option> <?php }?> </select> </tr> <tr> <td colspan="3" height="20"></td> </tr> <tr> <td align="center"><strong>8.</strong></td> <td>City & State </td> <td><input type="text" name="city" id="city" size="15" class="tetboxfield" value="<?php echo $_SESSION['city'];?>"/> <select name="state" id="state" class="selectInput3"> <option value="">--State--</option> <option value="GA"<?php if(isset($_SESSION['state']) && $_SESSION['state'] == 'GA'){ echo "selected";}?>>Georgia</option> </select></tr> <tr> <td colspan="3" height="10"></td> </tr> <tr> <td align="center" valign="top"><strong>9.</strong></td> <td><span style="float:left; width:100%;">E-mail Address</span> <span style="float:left; width:100%;color: red; font-size:13px;">This is for the youth's email address and no duplicates will be accepted. Adults, do not put <br/>your email address here. Your email will go on the 3rd page.</span></td> <td><input type="text" name="email" id="email" size="15" class="tetboxfield" value="<?php echo $_SESSION['email'];?>"/> </tr> <tr> <td colspan="3" height="10"></td> </tr> <!-- <tr> <td align="center"><strong>10.</strong></td> <td>Age </td> <td><input type="hidden" name="age" id="age" size="15" class="tetboxfield" value="50"/> </tr> <tr> <td colspan="3" height="30"></td> </tr>--> <input type="hidden" name="age" id="age" size="15" class="tetboxfield" value="50"/> <tr> <td align="center"> </td> <td align="left"><strong class="red">DISCLAIMER</strong>: <span class="red"><strong>All information will be verified for accuracy prior to selection.</strong></span></td> </tr> <tr> <td colspan="3" style="padding-left:700px;"> <input type="submit" name="next" value="Next" size="30px" /></td> </tr> <tr> <td colspan="3" height="30"></td> </tr> </table> <input type="hidden" name="action" value="addpage1" /> <input type="hidden" name="emailCheck" id="emailCheck"/> </form> </body> </html>
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